The demographics of playground equipment injuries in children

A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

A Pilot Randomized Trial Evaluating the Cool 2 Be Safe Junior Playground Safety Program for Preschool Children

OBJECTIVE

Unintentional injury is the leading cause of death to children worldwide, and playgrounds pose a significant risk of injury. Those aged 5 and 6 years are particularly vulnerable to playground injuries. Previous interventions have typically targeted environmental modifications or increased supervision to reduce playground injuries; however, minimal research has focused on implementing behavioral interventions that seek to change children's safety knowledge and risk-taking behaviors on the playground. The current randomized trial addressed these gaps in the literature and sought to increase preschool children's hazard awareness skills and knowledge of unsafe playground behaviors and decrease their intentions to engage in risk-taking behaviors on the playground.

METHOD

A total of 77 children aged 5 and 6 years were tested at a laboratory on a university campus, using a parallel group design, with 38 randomized to the playground intervention group and 39 randomly assigned to a control group. The intervention was manualized and delivered to small groups of children (3-5) over several sessions.

RESULTS

Statistical analyses revealed significant group differences. Intervention experience led to significant increases in hazard awareness skills and knowledge of unsafe playground behaviors, and significant decreases in children's risk-taking behavioral intentions, whereas those in the control group showed no significant changes in these scores. Attention scores for those in the intervention group highlighted that the program content was successful in maintaining children's attention and engagement, and memory scores indicated excellent retention of lesson content.

CONCLUSION

The program shows promise in addressing the issue of unintentional playground injuries in young children.

Comprehensive analysis of power tool injuries: implications for safety and injury prevention

BACKGROUND

Power tools are essential for productivity but carry significant injury risks. Addressing power tool injuries across diverse age groups is vital, as existing research predominantly focuses on specific occupational or non-occupational groups, leaving a gap in understanding various age cohorts within the diverse American population. This study aims to comprehend power tool injury epidemiology, raising awareness about the importance of targeted safety measures for enhancing public health.

METHODS

Using a ten-year retrospective approach, this study analyzed National Electronic Injury Surveillance System (NEISS) data from US hospital emergency departments (2013-2022). Demographic and temporal trends were examined, and associations between injury occurrence and categorical variables, including injured body parts, gender, and race, were explored.

RESULTS

In 2013, power tool injuries were highest in the "51-60″ age group (23.70 %), followed by "41-50″ (17.31 %) and "61-70″ (19.38 %). Injury rates varied across age groups over the years. Notably, the "41-50″ age group showed a significant decrease in injuries over time (χ² = 17.12, p < .05), indicating a notable temporal trend. Hand injuries were predominant (39.08 %), followed by finger (19.19 %), lower arm (11.25 %), upper arm (8.79 %), and face (4.04 %). Lacerations constituted the most frequent injury type (60.89 %), alongside fractures, amputations, foreign body insertions, and contusions/abrasions. Significant associations emerged between injury occurrence and gender (χ² = 6.19, p < .001), as well as race (χ² = 7.42, p < .001). Males accounted for the majority of injuries (95.97 %), while white individuals constituted the largest proportion (91.84 %). Females and domestic settings exhibited increasing proportions of power tool injuries.

CONCLUSIONS

The higher incidence among middle-aged individuals in domestic settings, coupled with evolving gender dynamics, underscores the need for targeted safety measures. Our findings contribute crucial novel insights, emphasizing tailored preventive strategies to enhance safety outcomes in the multifaceted landscape of power tool use.

Epidemiological Characteristics of School Playground Injuries

Reports of children's play-related injuries have remained stagnant according to epidemiology studies of the past 3 decades. This article provides a unique look into the context of playground injuries within an entire school district, demonstrating the prevalence of these injuries. This study reports that playgrounds are the leading location of school injury, comprising one-third of all elementary school injuries. This study found that while head/neck injuries were the most commonly injured body region within the playground environment, the proportion of head/neck injuries decreased with age, whereas the proportion of extremity injuries increased with age. At least 1 upper extremity injury required outside medical attention for every 4 that were treated on-site, making upper extremity injuries roughly twice as likely to require outside medical attention as injuries to other body regions. The data in this study are useful for interpreting injury patterns in the context and evaluation of existing safety standards for playgrounds.

Examination and Scientific Analysis of Thoracic Vertebral Fractures

Background Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.

Supracondylar humerus fractures in children caused by monkey bar-related injuries: a comparative study

We evaluated the functional and radiological outcomes of surgically treated supracondylar humerus fractures based on injury mechanisms, as well as the therapeutic and prognostic aspects of monkey bar-related injuries, in this study. Between December 2014 and December 2018, pediatric patients who had undergone surgical treatment for supracondylar humerus fractures were analyzed retrospectively. According to the mechanism of injury, patients were divided into two groups: monkey bar-related injuries and other injuries. Patients were evaluated functionally using the Mayo elbow performance score, while radiographically using the anterior humeral line, humero-capitellar angle, and Baumann angle. This study enrolled a total of 50 patients, 27 females and 23 males. Each patient was followed for a minimum of 24 months. There were no significant differences in age, sex or complications between the groups. The Mayo elbow performance score and fracture types were shown to be significantly associated with injury mechanisms ( P = 0.017, P < 0.001). Additionally, a significant correlation between the necessity for open reduction and the mechanism of injury was found ( P = 0.038). There were no significant differences in radiological evaluation between the groups. Supracondylar humerus fractures caused by falling from the monkey bar were more severe in children than supracondylar humerus fractures caused by other mechanisms of injury, and surgical treatment outcomes were worse for supracondylar humerus fractures caused by falling from the monkey bar.

Children's strategies in drop-landing

Introduction

Landing is a critical motor skill included in many activities performed in the natural environment by young children. Yet, landing is critically relevance to ensure proper stability and reduce injury. Furthermore, landing is an integral part of many fundamental motor skills which have been linked to greater physical activity, sport participation, and perceived competence in children. Our aim was to examine the drop-landing strategies of young children focusing on the lower extremity with a multi-variant approach.

Methods

Forty-four children divided into four age groups (G1:3–4.5 y, G2:4.5–6 y, G3:6–7.5 y, G4:7.5–9 y) performed 20 drop-land trials in four different conditions: predictable stationary landing, running to the left, to the right, and stay in place. Fifteen reflective markers, two force plates, and ten surface electromyography (sEMG) sensors were used to collect data. MANOVAs (Group x Condition) were conducted separately for the kinematic, kinetic, and sEMG variables.

Results

Only significant group effects were found (kinematic MANOVA p = 0.039, kinetic MANOVA p = 0.007, and sEMG MANOVA p = 0.012), suggesting that younger groups (G1, G2) differed to the older groups (G3, G4). G1 showed less knee flexion and slower ankle dorsi-flexion during the braking phase compared to G3, while G2 presented smaller ankle dorsi-flexion at the braking phase and smaller ankle range of motion than G3. Overall kinetic variables analysis showed a group difference but no group differences for any single kinetic variable alone was found. Regarding sEMG, G1 during the flight phase exhibited longer tibialis anterior and hamstrings activity than G3 and G3 &amp; G4, respectively; and an earlier start of the hamstrings' impact burst than G4. In addition, distal to proximal control was primarily used by all groups to coordinate muscle activity (in response to impact) and joint motion (after impact).

Discussion

Perhaps a developmental critical point in landing performance exists at 4–5 years of age since G1 presented the largest differences among the groups. This suggests that to improve landing strategies could start around this age. Future studies should examine if playground environments that include equipment conducive to landing and practitioners in the kindergarten schools are adequate vehicles to empower this type of intervention.

COVID-19 pandemic restrictions unmasks dangers of frequent injury mechanisms for common surgically treated pediatric fractures

PURPOSE

This study examined the volume and characteristics of common surgically treated fractures in children during the COVID-19 pandemic. The worldwide spread of COVID-19 affected the society in numerous ways. Social distancing led to changes in the types of activities performed by individuals, including children. Physicians saw a shift in orthopedic trauma volume and distribution. We predicted that with the change in activities children participated in, the number or type of injuries sustained would change as well.

METHODS

A retrospective review was performed of children who sustained a surgically treated fracture of the forearm, supracondylar humerus, femur, or any open fracture during the COVID-19 pandemic compared to the previous 2 years (pre-pandemic). Patient demographics, insurance status, and mechanism of injury were recorded. Statistical analysis was performed.

RESULTS

Review of the medical records identified 791 children. The number of fractures decreased from an average of 295 per year pre-pandemic to 201 during the pandemic (p = 0.09). During the pandemic, there was a decrease in injuries resulting from a fall from the monkey bars for supracondylar humerus (21.2% to 8.2%, p < 0.01) and for forearm fractures (15.5% to 4.3%, p = 0.04). In contrast, the frequencies of falls from a skateboard, hoverboard, scooter, or bicycle and falls from household furniture increased during the pandemic.

CONCLUSION

The observed decrease in monkey bar-related injuries provides further evidence as to the dangers of this piece of playground equipment in contributing to upper-extremity fractures in children.

LEVEL OF EVIDENCE

Level III: Prognostic and Epidemiological.

What About the Little Ones? Systematic Review of Cognitive and Behavioral Outcomes Following Early TBI

There is increasing empirical focus on the effects of early traumatic brain injuries (TBI; i.e., before the age of six years) on child development, but this literature has never been synthetized comprehensively. This systematic review aimed to document the cognitive, academic, behavioral, socio-affective, and adaptive consequences of early TBI. Four databases (Medline, PsycNET, CINAHL, PubMed) were systematically searched from 1990 to 2019 using key terms pertaining to TBI and early childhood. Of 12, 153 articles identified in the initial search, 43 were included. Children who sustain early TBI are at-risk for a range of difficulties, which are generally worse when injury is sustained at a younger age, injury severity is moderate to severe, and injury mechanisms are non-accidental. Early childhood is a sensitive period for the emergence and development of new skills and behaviors, and brain disruption during this time is not benign. Research, clinical management, intervention, and prevention efforts should be further developed with consideration of the unique characteristics of the early childhood period.

Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019

OBJECTIVE

To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children.

METHODS

We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates.

RESULTS

During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r² = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October.

CONCLUSION

Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.

Playground equipment-related extremity fractures in children presenting to US emergency departments, 2006-2016

Background

Despite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury. Fractures account for 35% of all playground injuries presenting to emergency departments (EDs). We aimed to examine the time trends and epidemiologic patterns of playground equipment-related extremity fractures in children in the United States.

Methods

We analyzed data from the National Electronic Injury Surveillance System. Children ≤14 years presenting to US emergency departments from 2006 to 2016 with playground equipment-related injuries were included. We used weighted complex survey analysis to describe the epidemiologic patterns and severity of playground equipment-related extremity fractures and Joinpoint linear weighted regression analysis to determine trends in extremity fractures.

Results

An annual average of 72,889 children were treated in US EDs for playground equipment-related extremity fractures, yielding a national annual incidence rate of 119.2 per 100,000 children. Playground equipment-related extremity fractures accounted for 33.9% of ED presentations and 78.7% of hospitalizations for playground equipment-related injuries. Of patients with playground equipment-related extremity fractures, 11.2% had severe fractures requiring hospitalization. The annual rate of ED visits due to playground equipment-related extremity fractures remained stable (annual rate of change = 0.74, p = 0.14) from 2006 to 2016. Adjusted for age, injuries on monkey bars or climbing gyms were associated with significantly increased odds of extremity fractures in comparison to injuries from other playground equipment (adjusted odds ratio [aOR]: 2.0; 95% CI: 1.9–2.1). Overall, 49.8% of extremity fractures and 54.7% of severe extremity fractures (i.e. those requiring hospitalization) occurred on monkey bars or climbing gyms.

Conclusions

Despite enhanced playground safety standards, national rates of playground equipment-related extremity fractures have remained stable in the US. Extremity fractures remain the most common type of playground injury presenting to EDs and most commonly occur on monkey bars and climbing gyms.

Playground-related Extremity Fractures in an Asian Setting over the Last Decade - Are We Safe?

The cost of playground-related injuries remains significant. Measures adopted to prevent such fractures or reduce their severity would translate into appreciable financial savings. Our study looks at the changes in playground-related extremity fracture epidemiology over the past decade after the implementation of latest playground standards. This is a retrospective case series approved by the local ethics board comparing the results of two descriptive studies; one conducted prior to the implementation of the Singapore Productivity and Standards Board Singapore Standards SS 457: 2007 and the other thereafter. The demographics have remained the same. The proportion of public playground injuries has fallen significantly from 89.6% to 76.3% (p < 0.05), whereas school playground injuries have risen from 5.9% to 18.0% (p < 0.05). Fractures related to monkey bars and the flying fox have shown a significant improvement, decreasing to 38.1% from 47.6% (p < 0.05) and 1% from 6.9% (p < 0.05), respectively. There has been a decrease of 33% in playground-related injuries. The total financial cost of sustaining one playground-related extremity fracture has generally increased by 50%. However, considering the 37.4% drop in surgeries, the actual overall costs to the healthcare system have essentially fallen. Safety standards have had a positive effect on playground safety in Singapore. There are now fewer and less severe playground-related extremity fractures.

Epidemiology of playground equipment related/unrelated injuries to children: A registry-based cohort study from 6 emergency departments in Korea

The aim of study was to understand the epidemiology of playground injury and to find the factors related to the clinically significant injuries. This retrospective observational study enrolled children (age 0-18 years old) who visited the emergency departments (ED) of 6 hospitals in Korea.We obtained and analyzed the data from the ED injury surveillance system, which was supported by the Korea Centers for Disease Control. Clinically significant injury (Cs injury) was defined as the injuries that caused hospital admission for more than one day. The factors associated with injury and clinical outcome were compared between admitted and discharged patient groups. Multivariable logistic regression and the population attributable fraction were used to identify significant factors for hospitalization.A total of 1458 patients were enrolled. The proportion of patients who visited ED due to injuries unrelated to the playground equipment use was 57.8%. The majority of Cs injury was upper extremity fractures (68.1%). The risk factors for admission were the 6- to 11-year old age group (OR 5.7, 95% CI 1.3-25.0) and public playground (OR 2.4, 95% CI 1.1-5.3); the population attributable factor of these factors was 51.3% and 36.0%, respectively.This study shows that approximately 60% of the patients visited ED due to injury unrelated to the playground equipment use. The risk factors of Cs injuries were ages 6 to 11 and public playgrounds. The results of the study can be helpful to formulate the prevention policy against playground injury.

Pediatric Playground-Related Injuries Treated in Hospital Emergency Departments in the United States

This study analyzed pediatric playground-related injuries data from the National Electronic Injury Surveillance System. An estimated 5 025 440 children <18 years were treated in US emergency departments for playground-related injuries during 1990-2012, averaging 218 497 children annually. The average patient age was 6.5 years. The overall annual injury rate declined during 1990-2007 ( P < .001) and then increased during 2007-2012 ( P < .001). The climbing equipment-related injury rate remained constant during 1990-2009 and then increased during 2007-2012 ( P = .014). The concussion/closed head injury rate increased during 1990-2008 ( P < .002) with the rate almost doubling from 2008-2012 ( P < .001). Falls accounted for 76.7% of all injuries and 87.7% of injuries to the upper extremities. Injuries resulted in hospitalization for 4.3% of patients. Despite current playground safety standards and guidelines, a large number of playground-related injuries continue to occur. Revised impact attenuation criteria for playground surfacing materials should be implemented and evaluated to more adequately prevent fall-related upper extremity fractures.

Playground slide-related injuries in preschool children: increased risk of lower extremity injuries when riding on laps

Background

The purpose of this study was to better understand the factors associated with playground slide-related injuries in preschool children and to test the hypothesis that riding on laps increases the likelihood of lower extremity injuries.

Methods

Playground slide-related injuries (product code 1242) in children ≤5 years of age treated in emergency departments from 2002 to 2015 were identified (N = 12,686) using the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). Descriptive and comparative analyses, including chi-square testing and binary logistic regression, were performed.

Results

Based on NEISS stratified national sampling estimates, over 350,000 children ≤5 years of age were injured on slides from 2002 to 2015. Overall, 59% of the children were male, and 65% were white. Almost 60% of injuries occurred in parks or other public areas. The most frequent diagnosis was a fracture (36%); lacerations were 19% of the injuries. A higher proportion of musculoskeletal injuries were seen in toddlers < 3 years old as compared to those 3–5 years of age (p < 0.001). Injuries to the lower extremities increased in frequency as age decreased, whereas injuries to the upper extremities and head/neck/face were more common in older preschoolers. Children < 3 years of age were 12 times more likely to be identified from narratives as being on another person’s lap at the time of injury. Children identified as being on a lap had an increased odds of injury to the lower extremity than to other body parts (OR 43.0, 95% confidence interval (CI) 32.0–58.0), and of lower leg/ankle fracture than fractures elsewhere (OR 49.5, 95% CI 31.7–77.4).

Conclusions

Decreasing age was associated with a higher likelihood of being identified as sliding down on another person’s lap and a higher likelihood of lower extremity injuries. Healthcare providers should be mindful of the potential for these slide-related injuries as they can result in a toddler’s fracture of the tibia, which may be occult. Parents should also be made aware of this increased risk and counseled that a child’s foot can catch on the slide’s surfaces when going down on a person’s lap with subsequent twisting forces that can result in a fracture.

Playground Equipment Related Injuries in Preschool-Aged Children: Emergency Department-based Injury In-depth Surveillance

In this study, we investigated playground equipment related injuries in preschool-aged children. This was a retrospective observational study using Emergency Department based Injury In-depth Surveillance, (2011-2014). We included the preschool-aged children with playground equipment related injuries. We surveyed the mechanism and incidence of injuries, and estimated the odds ratio (OR) of traumatic brain injury (TBI) and upper/lower extremities fracture. There were 6,110 patients, mean age was 4.14 ± 1.95 years old. Slide and swing related injuries were 2,475 (40.5%) and 1,102 (18.0%). Fall down (48.5%) was the most common mechanism. The OR of TBI in children 0-2 years old was 1.88 times higher than children 3-7 years old, and in swing was 4.72 (OR, 4.72; 95% confidence interval [CI], 2.37-9.40) times higher than seesaw. The OR of upper extremity fracture in children 3-7 years old was 3.07 times higher than children 0-2 years old, and in climbing was 2.03 (OR, 2.03; 95% CI, 1.63-2.52) times higher than swing. The OR of lower extremity fractures in horizontal bars, tightropes, and trampolines was 2.95 (OR, 2.95; 95% CI, 1.55-5.61) times higher than swing. The most common mechanism and playground equipment were fall down and slide. TBI was associated to younger children (0-2 years old) and swing. Fracture of upper extremities was associated to older children (3-7 years old) and climbing. Fracture of lower extremities was associated to others such as horizontal bars, tightropes, and trampolines.

Soccer-Related Facial Trauma: A Nationwide Perspective

PURPOSE

Soccer participation continues to increase among all ages in the US. Our objective was to analyze trends in soccer-related facial injury epidemiology, demographics, and mechanisms of injury.

MATERIALS AND METHODS

The National Electronic Injury Surveillance System was evaluated for soccer-related facial injuries from 2010 through 2014. Results for product code "soccer" were filtered for injures to the face. Number of injuries was extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and mechanisms.

RESULTS

In all, 2054 soccer-related facial trauma entries were analyzed. During this time, the number of injures remained relatively stable. Lacerations were the most common diagnosis (44.2%), followed by contusions and fractures. The most common sites of fracture were the nose (75.1%). Of fractures with a reported mechanism of injury, the most common was head-to-head collisions (39.0%). Patients <19 years accounted for 66.9% of injuries, and athletes over 18 years old had a higher risk of fractures.

CONCLUSIONS

The incidence of soccer-related facial trauma has remained stable, but the severity of such injuries remain a danger. Facial protection in soccer is virtually absent, and our findings reinforce the need to educate athletes, families, and physicians on injury awareness and prevention.

EMS Activations for School-Aged Children From Public Buildings, Places of Recreation or Sport, and Health Care Facilities in Pennsylvania

OBJECTIVES

To determine the etiology of emergency medical services (EMS) activations in 2011 to public buildings, places of recreation or sport, and health care facilities involving children aged 5 to 18 years in Pennsylvania.

METHODS

Electronic records documenting 2011 EMS activations as provided by the Pennsylvania Department of Health's Bureau of EMS were reviewed. Data elements (demographics, dispatch complaint, mechanism of injury, primary assessment) from patients aged 5 to 18 years involved in an EMS response call originating from either a public building, a place of recreation and sport, or health care facility were analyzed.

RESULTS

A total of 12,289 records were available for analysis. The most common primary assessments from public buildings were traumatic injury, behavioral/psychiatric disorder, syncope/fainting, seizure, and poisoning. The most common primary assessments from places of recreation or sport were traumatic injury, syncope/fainting, altered level of consciousness, respiratory distress, and abdominal pain. The most common primary assessments from health care facilities were behavioral/psychiatric disorder, traumatic injury, abdominal pain, respiratory distress, and syncope/fainting. When examining the mechanism of injury for trauma-related primary assessments, falls were the most common mechanism at all 3 locations, followed by being struck by an object. Of the 1335 serious-incident calls (11% of the total EMS activations meeting inclusion criteria), 61.2% were from public buildings, 14.1% from places of recreation or sport, and 24.7% from health care facilities.

CONCLUSIONS

Our identification of common EMS dispatch complaints, mechanisms of injury, and primary assessments can be used in the education of staff and preparation of facilities for medical emergencies and injuries where children spend time.

Nonfatal Playground-Related Traumatic Brain Injuries Among Children, 2001-2013

OBJECTIVE

To describe the circumstances, characteristics, and trends of emergency department (ED) visits for nonfatal, playground-related traumatic brain injury (TBI) among persons aged ≤14 years.

METHODS

The National Electronic Injury Surveillance System-All Injury Program from January 1, 2001, through December 31, 2013, was examined. US Census bridged-race population estimates were used as the denominator to compute rates per 100 000 population. SAS and Joinpoint linear weighted regression analyses were used to analyze the best-fitting join-point and the annual modeled rate change. These models were used to indicate the magnitude and direction of rate trends for each segment or period.

RESULTS

During the study period, an annual average of 21 101 persons aged ≤14 years were treated in EDs for playground-related TBI. The ED visit rate for boys was 39.7 per 100 000 and 53.5 for persons aged 5-9 years. Overall, 95.6% were treated and released, 33.5% occurred at places of recreation or sports, and 32.5% occurred at school. Monkey bars or playground gyms (28.3%) and swings (28.1%) were the most frequently associated with TBI, but equipment involvement varied by age group. The annual rate of TBI ED visits increased significantly from 2005 to 2013 (P < .05).

CONCLUSIONS

Playgrounds remain an important location of injury risk to children. Strategies to reduce the incidence and severity of playground-related TBIs are needed. These may include improved adult supervision, methods to reduce child risk behavior, regular equipment maintenance, and improvements in playground surfaces and environments.

Occupational Embeddedness, Perceived Risk, and the Quality of Reach Motion in Females Aged 7 to 9 Years

The perceived meaning ascribed to objects can influence the motor control efficiency in adults when reaching. However, little is known whether the same phenomenon occurs in pediatric females. Twenty-seven girls aged 7 to 9 years recruited from Girl Scout Brownie troupes and afterschool programs were asked to reach for plastic and porcelain teacups in the context of a "tea party" scenario. No differences were found in most of the motion capture variables (p > .05), and effect sizes were small. It is likely that the perceived meaning of the tea party was so robust that it overwhelmed any perceived differences inherent between the two conditions. Future research is needed to clarify the age at which children can qualitatively discern meaningful differences between objects.

Compliance of camps in the United States with guidelines for health and safety practices

OBJECTIVE

To determine the compliance of US camps with guidelines for health and safety practices as set forth by the American Academy of Pediatrics and the US Department of Homeland Security.

METHODS

An electronic questionnaire was distributed to US camps during the summer of 2012 as identified by 3 online summer camp directories.

RESULTS

Analysis was performed on 433 completed questionnaires. Fourteen percent of camps were considered medically related. Ninety-three percent of camps have established relationships with community emergency medical services, 34% with local orthodontists, and 37% with local mental health professionals. Camps reported the immediate availability of the following: automated external defibrillators (75%), respiratory rescue inhalers (44%), epinephrine autoinjectors (64%), cervical spine collars (62%), and backboard with restraints (76%). Camps reported the presence of the following written health policies: dehydration (91%), asthma and anaphylaxis (88%), head injuries (90%), seizures (78%), cardiac arrest (76%), and drowning (73%). Although 93% of camps have a disaster response plan, 15% never practice the plan. Sixty-eight percent of camps are familiar with community evacuation plans, and 67% have access to vehicles for transport. Camps reported the presence of the following written disaster policies: fire (96%), tornadoes (68%), arrival of suspicious individuals (84%), hostage situations (18%).

CONCLUSIONS

Areas for improvement in the compliance of US camps with specific recommendations for health and safety practices were identified, such as medically preparing campers before their attendance, developing relationships with community health providers, increasing the immediate availability of several emergency medications and equipment, and developing policies and protocols for medical and disaster emergencies.

Severity of playground-related fractures: more than just playground factors?

INTRODUCTION

Despite the establishment of playground safety standards, playground-related injuries are still a significant cause of extremity fractures in Singapore. This prospective study evaluates the dimensions and characteristics of our playgrounds, and their effect on fracture severity in an Asian population. We aim to correlate various playground risk factors with severity of the fractures and give recommendations on future safety standards. Our data also allows us to compare the demographics of patients in our study group with that collected in our earlier study in 2004.

METHODS

From June 2005 to 2006, children who presented with extremity fractures to KK Women's and Children's Hospital after a playground injury were enrolled. Their clinical data were collected prospectively. Relevant playground details were collected on-site independently by another investigator. For analysis of severity, fractures were "major" if they required reduction or operative fixation and were "minor" if they did not.

RESULTS

Supervision at time of injury, especially from the child's parents or siblings, resulted in a lower likelihood of "major" fractures (P=0.002, likelihood ratio=1.97). Conversely, supervision from grandparents or maids was found to result in a higher likelihood of "major" fractures. Increased weight of patients was directly related to severity of fractures (P=0.000), and a body mass index (BMI) of less than 19.8 kg/m resulted in lower likelihood of "major" fractures (P=0.010, likelihood ratio=2.22). Height of equipments and other playground-related factors were not linked to severity of fractures.

CONCLUSIONS

Supervision at the playground, preferably from the child's parents or siblings, and keeping a child's BMI within limits as guided by the BMI charts, may potentially reduce the occurrence of severe fractures.

LEVEL OF EVIDENCE

Level I-prognostic study.

Pediatric genital injury: an analysis of the National Electronic Injury Surveillance System

OBJECTIVE

To describe the characteristics of pediatric genital injuries presenting to United States emergency departments (EDs).

METHODS

A retrospective cohort study utilizing the U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) from 1991-2010 to evaluate pediatric genital injuries was performed.

RESULTS

Pediatric genital injuries represented 0.6% of all pediatric injuries with the incidence of injuries rising through the period studied, 1991-2010. The mean age at injury was 7.1 years old and was distributed 56.6% girls and 43.4% boys. A total of 43.3% had lacerations and 42.2% had contusions/abrasions. The majority of injuries occurred at home (65.9%), and the majority of patients (94.7%) were treated and released from the hospital. The most common consumer products associated with pediatric genital trauma were: bicycles (14.7% of all pediatric genital injuries), bathtubs (5.8%), daywear (5.6%), monkey bars (5.4%), and toilets (4.0%).

CONCLUSION

Although pediatric genital injuries represent a small proportion of overall injuries presenting to the emergency department, genital injuries continue to rise despite public health measures targeted to decrease childhood injury. Our results can be used to guide further prevention strategies for pediatric genital injury.

Playground safety and quality in chicago

OBJECTIVES

To assess playground safety and quality in Chicago, Illinois, identify disparities in access, and use the data to inform collaborative improvement.

METHODS

A cross-sectional survey of public park playgrounds in Chicago, Illinois, was conducted in 2009, 2010, and 2011 by using the National Program for Playground Safety Standardized Survey. All playgrounds were surveyed in 2009 and 2010; those that failed in 2010 were resurveyed in 2011. Playgrounds were assessed in 4 main categories: age-appropriate design, fall surfacing, equipment maintenance, and physical environment. Safety scores were generated from the assessment. Geographic information system mapping provided a visual description of the playground pass/fail rate based on neighborhood, child population, race/ethnicity, and poverty level.

RESULTS

Of the ∼500 playgrounds, 467 were assessed in 2009, and 459 were assessed in 2010. In 2009, half of all playgrounds (55%) and in 2010, nearly two-thirds (61%) earned scores consistent with safe playgrounds (P < .001). Playgrounds scored poorest in fall surfacing and equipment maintenance. Geographic information system mapping showed neighborhoods with a higher percentage of children and impoverished families had fewer playgrounds and more failing playgrounds. In 2011, 154 (85%) of the playgrounds that failed in 2010 were surveyed. The mean playground score among failing playgrounds improved significantly between 2010 (61%) and 2011 (67%, P < .001).

CONCLUSIONS

Since the playground improvement initiative began in 2009, considerable progress has been made in the safety scores, although access to high-quality playgrounds varies by neighborhood. Many failing playgrounds can be brought up to standard with improvement in fall surfacing and equipment maintenance.

Height, fun and safety in the design of children's playground equipment

The study reported in this paper adopted a holistic design approach to investigate issues associated with height related playground injuries from a users' perspective. The main objective was to gain an understanding of the relationship between height and fun so as to establish practical guidelines for addressing the causes of height related injuries whilst maintaining the attributes of playground equipment that children find fun and challenging. Results show that, on the one hand, the risk of injury increases when height is coupled with the use of upper body strength and, on the other hand, that coordination is a greater source of fun and challenge than height for children. Accordingly, it is suggested that the level of risk of injury attached to children's playground equipment can be reduced when the use of lower body strength and coordination are combined with lower free fall heights.

Playground injuries in children

Background

Rapid urbanization and unplanned population development can be detrimental to the safety of citizens, with children being a particularly vulnerable social group. In this review, we assess childhood playground injuries and suggest safety mechanisms which could be incorporated into playground planning.

Methods

Inclusion criteria were “children” as the focus group, “playground” as the main field of study, and “unintentional injury” and “safety” as the concepts of study. The keywords used for the PubMed search were “playground”, “children”, and “injury”. Initially we 182 articles. After screening according to inclusion criteria, 86 articles were found, and after reading the abstracts and then the full text, 14 articles were finally included for analysis. The papers reviewed included four case-control studies, three case studies, three descriptive studies, two interventional studies, one retrospective study, one cross-sectional study, and one systematic review.

Results

Playground-related fractures were the most common accidents among children, underscoring the importance of safety promotion and injury prevention in playgrounds, lowrisk equipment and playing hours (week days associated with higher risk), implementation of standards, preventing falls and fall-related fractures, and addressing concerns of parents about unsafe neighborhoods. With the exception of one study, all of the reviewed papers had not implemented any practical safety plan. Safe engineering approaches were also ignored.

Conclusion

We recommend a systematic safety approach based on the “safety circle” which includes three main areas, ie, equipment, environment, and children.

The cost of sustaining playground related extremity fractures in Singapore

PURPOSE

To study the cost of sustaining a fracture of the extremity caused by playground equipment. These costs include financial, psychological, clinical and others like loss of school days.

METHOD

This is a prospective study of 226 children seen at the Paediatric Orthopaedic Department for a1-year period starting June 2005. Once confirmed to have a playground related fracture by the Orthopaedic specialist, three sets of data are collected. First is the clinical data. Second is the playground related data. This is done on site independently by another investigator. Third is the radiological data,which is assessed independently by an Orthopaedic surgeon to ensure consistency.

RESULTS

Out of the 226 children seen, two-thirds were boys. The average age was 7.5 years. 35.8% were forearm fractures and 28.8% were supracondylar fractures with the rest being mostly fractures in the upper limb. 64.2% were treated with immobilisation only whilst 24.2% required closed manipulation and reduction. 1.2% required admission for treatment of their fractures. The average period of cast immobilisation was 34 days. The average number of consults, including that at the emergency department, was 4 with an average length of follow up of 67.2 days. Based on the above, in our institution, the average cost for outpatient treatment would be about S$680.00 (US$485.71) (US$1.00 = S$1.40; 1/1/2010) per injury. The inpatient cost for non-surgical treatment cost would be S$1000.00 and for surgical stabilisation the average cost would be S$3300.00 (US$2357.14).

CONCLUSION

Playgrounds are meant for children to play safely. Yet, there appears to be a significant number of injuries sustained. Whilst these fractures are relatively minor, requiring outpatient treatment,there are costs. Besides the financial costs, there are hidden psychological costs of loss of school days and inability to participate in sports. Finally, as with any injury, there can be long-term complications which present further clinical costs.

SIGNIFICANCE

Most studies on playground injuries tend to concentrate on the equipment and very superficially cover the clinical aspects, less so the costs. This paper looks at the clinical aspects in greater depth and emphasises that there are significant costs, beyond financial, when a child sustains a playground injury. The next thing to do is to examine what playgrounds factors significantly contribute to these injuries and remedy them when planning the construction of playgrounds.

Tibia fractures in children sustained on a playground slide

BACKGROUND

The purpose of this study is to investigate the relationship between children who sustain tibia fractures on a playground slide and the mechanism of injury.

METHODS

This retrospective review included the chart and radiographs of all children diagnosed with a tibia fracture, over an 11-month period. All patients were originally seen in either the emergency room of a level 1 trauma center or the treating physician's office.

RESULTS

During the period of study, 58 fractures of the tibia were found. Eight (13.8%) of the tibia fractures were sustained while playing on a playground slide. The 8 fractures identified are the focus of this study. The tibia fractures were nondisplaced, diaphyseal, with an intact fibula. There were 5 female and 6 male children included in the study. The age range of the patients with a tibia fracture sustained while going down a slide was 14 months to 32 months; the average age of the 8 children in this study was 20.6 months. The average age of boys sustaining a tibia fracture on a playground slide was found to be 20.7 months and the average age of girls was found to be 20.6 months. All tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult. None of the 8 children studied went down the slide alone.

CONCLUSIONS

Children at risk for tibia fractures sustained while going down a playground slide, on the lap of an adult, were found to be less than 32 months of age. Many parents believe they are increasing the safety of their young child by placing the child on their lap while going down a playground slide. Parents should be educated not to go down a slide with a child on their lap. If the child is unable to use the slide independently, another activity would be more appropriate.

LEVEL OF EVIDENCE

Therapeutic study, level IV.

Advances in the prevention of children's injuries: an examination of four common outdoor activities

PURPOSE OF REVIEW

Injuries remain the leading cause of death for children. Experts in paediatrics and child health have a current interest in promoting children's healthy active living. This review highlights findings from recent literature regarding the prevention of injuries from four common outdoor activities: bicycling, snowboarding and skiing, walking and playground activity.

RECENT FINDINGS

There is sound evidence for the effectiveness of bicycle helmets, the promotion of bicycle helmets at a community level and through physician counselling, and legislation; for the effectiveness of helmets for skiing and snowboarding; for the effectiveness of implementing playground safety standards; and for the effectiveness of modifications to the pedestrian physical environment.

SUMMARY

The science of injury prevention has advanced considerably. The highest level of evidence, including systematic reviews, is now available regarding the effectiveness of protective measures, engineering approaches to the environment and legislation. Healthcare providers caring for children play a leading role in injury prevention through child and family counselling, advocacy and research.